Although about thirty countries have the death penalty for drug trafficking, only in China, Indonesia, Iran, Malaysia, Saudi Arabia, Singapore, and Vietnam are drug offenders routinely executed. Yet, the worst place to be caught drug trafficking is in the Philippines, where thousands have died in extra-judicial killings.

In the United States, not only can some drug offenses result in life in prison, “the sentence of death can be carried out on a defendant who has been found guilty of manufacturing, importing or distributing a controlled substance if the act was committed as part of a continuing criminal enterprise.”

President Trump has said some outrageous things. He has said some dumb things. And he has said some outrageously dumb things. But talking about the death penalty for drug dealers is one of the most outrageously dumb things he has ever said.

It was revealed last year that Trump said during a phone call with Philippines President Rodrigo Duterte: “I just wanted to congratulate you because I am hearing of the unbelievable job on the drug problem. Many countries have the problem, we have a problem, but what a great job you are doing and I just wanted to call and tell you that.”

Then it was reported that Trump has privately told a number of people that he supports executing drug dealers.

And just the other day, speaking at a White House summit on the opioid epidemic, Trump said this:

Some countries have a very, very tough penalty. The ultimate penalty. And by the way they have much less of a drug problem than we do. So we’re going to have to be very strong on penalties.

We have pushers and we have drug dealers that kill hundreds and hundreds of people and most of them don’t even go to jail. If you shoot one person, they give you life, they give you the death penalty. These people can kill 2,000, 3,000 people and nothing happens to them.

But Trump is not alone. Newt Gingrich has likewise entertained the same despicable idea.

Trump, Gingrich, and the hardcore conservative drug warriors who would support the death penalty for drug traffickers have their sights on the wrong target. Alcohol and tobacco dealers cause much more harm and kill far more people with their products.

Drinking too much can harm your health. Excessive alcohol use led to approximately 88,000 deaths and 2.5 million years of potential life lost (YPLL) each year in the United States from 2006 – 2010, shortening the lives of those who died by an average of 30 years. Further, excessive drinking was responsible for 1 in 10 deaths among working-age adults aged 20-64 years. The economic costs of excessive alcohol consumption in 2010 were estimated at $249 billion, or $2.05 a drink.

Learning and memory problems, including dementia and poor school performance.

Mental health problems, including depression and anxiety.

Social problems, including lost productivity, family problems, and unemployment.

Alcohol dependence, or alcoholism.

For pregnant women, no amount of alcohol consumption during pregnancy is known to be safe:

Alcohol consumption during pregnancy is associated with spontaneous abortions, birth defects, and developmental disorders, many of which occur early in gestation before the woman is aware that she is pregnant. Alcohol use during pregnancy is associated with fetal alcohol spectrum disorders (FASDs), which may be characterized by specific physical features, impaired growth and abnormal development or functioning of the central nervous system.

Smoking also increases the risk of dying from cancer and other diseases in cancer patients and survivors.

Smoking harms nearly every organ of the body and affects a person’s overall health.

Smoking can make it harder for a woman to become pregnant.

Smoking can affect bone health.

Smoking affects the health of your teeth and gums and can cause tooth loss.

Smoking can increase your risk for cataracts and macular degeneration.

Smoking is a cause of type 2 diabetes mellitus and can make it harder to control.

Smoking causes general adverse effects on the body, including inflammation and decreased immune function.

Smoking is a cause of rheumatoid arthritis.

If the government should execute drug dealers, then why should it not also execute alcohol and tobacco dealers? Why not destroy distilleries, breweries, and wineries and execute their workers? Why not round up the owners of, and clerks at, grocery stores, convenience stores, and liquor stores and execute them for causing the deaths of thousands of people?

Seems rather ludicrous to single out drug dealers, doesn’t it?

So, what should the government do about the health problems resulting from the use of alcohol, tobacco, and drugs? What should the government do about binge drinking, chain smoking, and drug abuse?

Absolutely nothing.

Although libertarians certainly recognize the potential negative effects of alcohol, tobacco, and drug use on the user’s health, safety, well-being, finances, family, job, reputation, etc., they don’t believe it is the responsibility of government to provide solutions to any problems resulting from the use of these substances. And certainly not solutions that criminalize the use of substances the government doesn’t approve of. Better solutions are to be found in family, friends, acquaintances, co-workers, physicians, psychologists, psychiatrists, social workers, anti-alcohol, anti-tobacco, and anti-drug organizations, religion, churches, ministers, rescue missions, Alcoholics Anonymous-type programs, and treatment centers.

Ultimately, the users of alcohol, tobacco, and drugs are responsible for their own choices and actions.

‘It’s a disease where some element of personal responsibility must still play some role’

A person prepares a needle at a supervised injection site in Toronto. (Darryl Dyck/Canadian Press)

There is a reason the Alberta NDP announced it was opening up “supervised consumption sites” in Calgary late last year.

There’s also a reason they avoided the more commonly known term: safe injection sites.

It’s because while there may, indeed, be a plethora of evidence to suggest that these sites save lives and reduce the spread of disease for people suffering from addiction, they also raise concerns among people who feel we’re moving more toward enabling addicts, than helping them live free of their demons.

While many of us have come around to the idea of drug addiction as a disease — it’s a disease where some element of personal responsibility must still play some role.

Medical research supports the use of safe injection sites. (Darryl Dyck/Canadian Press)

Some never try drugs.

Some try, but never get addicted.

Some addicts try to get off drugs, and fail.

Some addicts try and succeed.

There is some combination of genetics, upbringing, trauma and, yes, choice, that we’ve yet to fully unravel in all of this.

But we are more than rats pulling a lever.

‘Helping addicts inject poison’

Safe injection sites don’t appear to raise the public ire as they once did — particularly now that the opioid epidemic sweeping Alberta is collecting exponentially more lives every year.

Or, rather, they didn’t seem to be terribly controversial until United Conservative Party Leader Jason Kenney decided to make them so.

In a lengthy Facebook post last week, he wrote, “We absolutely need to show compassion for those suffering with addiction, and we need to help them get off drugs.

“But helping addicts inject poison into their bodies is not a long-term solution to the problem.” And there’s the dilemma.

But while the public outcry was apparent, the inner gut wrench was not.

An NDP MLA with more moral authority on the subject than Kenney responded: “He depersonalized anybody with an addiction and labelled them as this horrible person who was bent on doing this awful behaviour,” Debbie Jabbour told Postmedia.

Her daughter died of an overdose in 2017.

Then, Kenney seemed to walk back his comments a few days later, acknowledging a Supreme Court case against the Harper government, which ensures consumption sites can’t be denied a license by the government.

If this back-and-forth is indicative of all the deftness Kenney can muster to outmaneuver the NDP on social issues — well, bub’s still got some work to do.

“I’m not saying I’m opposed to reasonable harm reduction efforts, but I am saying that we need to be realistic about this,” Kenney told Global News.

But he did raise some fair questions about where the logic of such an approach will inevitably takes us.

A moral divide

If we are going to treat drug addiction as a chronic disease — no different in its moral dimension to other lifestyle-impacted illnesses like diabetes or hypertension — then the path becomes clear.

We should offer prevention and abstinence where possible, and ongoing treatment where it is not.

And this will mean providing some chronic addicts lifelong access to clean, regulated drugs so they can manage their addiction.

Just because alcohol is legal doesn’t mean it should be disqualified from harm-reduction programs, says a University of Victoria psychologist.

“Alcohol can kill you in more ways than heroin can,” said Tim Stockwell, director of the Canadian Institute for Substance Use Research.

“But somehow it doesn’t deserve the same level of respect in harm-reduction treatments as other substances.”

Stockwell, a psychology professor, and Bernie Pauly, associate professor in the UVic department of nursing, edited a special issue of the international, peer-reviewed Drug and Alcohol Review that includes four papers from the Canadian Managed Alcohol Program Study.

The study examined programs in which participants are provided daily, regular and measured doses of alcohol to cope with their addictions. The doses, usually equivalent to one standard drink, are usually offered at intervals, such as every hour or 90 minutes. Housing, food and other supports are typically provided, as well.

Stockwell said managed-alcohol programs are a radical idea being pursued seriously only in Canada. One of the first arose 25 years ago after three people froze to death in Toronto. They had been denied shelter spaces because they were drunk.

Data for the papers were collected from about 380 people in 13 programs across Canada, including two in the Lower Mainland.

Susan Alexman, director of programs for PHS Community Services Society in Vancouver, said her agency is offering two managed-alcohol programs, one as part of a subsidized-housing project.

The other PHS service is community-based. Clients are expected to show up at the PHS centre for drinks, in some cases getting them in exchange for things such as non-beverage alcohol, which includes mouthwash and rubbing alcohol.

Don Evans, executive director of Our Place in Victoria, said his group has considered managed alcohol in the past but gave up because it didn’t have the space or resources.

‘We can’t forget behind these numbers are individuals and families who are affected,’ says doctor

Health officials urged the City of Vancouver to provide safe opioids to drug users as another tactic to combat the ongoing health crisis. (Graeme Roy/Canadian Press)

Health officials have urged Vancouver city council to push forward with new strategies to curb the high opioid death rate, including providing a safe supply of drugs to addicts.

Dr. Patricia Daly with Vancouver Coastal Health and Dr. Mark Tyndall with the B.C. Centre for Disease Control made the suggestion during a presentation to council at city hall Wednesday morning.

“We’ve become so used to this horrible situation,” Tyndall said. “We have to do something different.”

About 300 people died from drug overdoses in Vancouver last year, with numbers yet to come for the last two months of the year.

Daly said she expects the numbers across the province to top 1,400 once the final tally comes from the B.C. Coroners Service.

Deaths preventable, says doctor

“The deaths are still far too high. These are people who are at the prime of their life — almost all the deaths are between 19 and 59 years of age,” Daly said.

“We can’t forget behind these numbers are individuals and families who are affected. Everyone of these deaths is preventable.”

Tyndall and Daly were joined by the city’s fire chief and the city’s managing director of social policy.

Daly said the number of overdose deaths in Vancouver has improved since last April — including numbers from police and hospital emergency departments that suggest that the number of opioid-related deaths didn’t increase over the Christmas holiday period.

The previous year, that number rose over the holidays.

The improvement shows that some of the city’s current strategies, which include supervised injection sites, Naloxone distribution and addiction treatment, have been helpful.

‘We have to do something different’

But Tyndall advised the city to keep on trying new strategies to fight the opioid crisis, including providing safe drugs who need help beyond the current tactics.

An increase in sites has not been matched by an increase in complaints

Insite in Vancouver was the first city in North America to open a supervised injection site nearly 15 years ago. Now there are 22 sites approved in Canada. (Darryl Dyck/CP file photo)

In the space of two years, the number of supervised consumption sites approved to operate in Canada has gone from one to 22, plus three interim sites.

In November 2015, when Justin Trudeau’s new Liberal government was sworn in, there was only Vancouver’s Insite.

Health Canada has now granted approval to two dozen new sites in 11 cities. There are permanent or mobile facilities approved for Victoria, Surrey, Kelowna, Kamloops, Vancouver, Calgary, Edmonton, Lethbridge, Toronto, Ottawa and Montreal. Another five applications are pending.

That simple count alone might suggest that the debate over supervised consumption sites, or at least the most pitched and divisive version of that debate, is rapidly receding into the past.

There also appears to be a difference of tone in the partisan discussion.

Measuring political opposition

Interviewed by CBC News in British Columbia earlier this year, Conservative Leader Andrew Scheer ranged from being somewhat critical to unenthusiastic about such facilities. And while his comments this week to the Globe and Mail fall short of a full endorsement for such facilities, there does seem to be something like openness.

“My message to people in British Columbia and Vancouver is a sincere desire to find policy that works, balancing the legitimate and proper concerns of families and individuals who have real concerns about [supervised consumption] in their community with the need to save lives, the recognition that addicts are in a type of place where they will do what they can to get their hands on narcotics and take them,” Scheer said.

Conservative Leader Andrew Scheer might not be enthusiastic about supervised consumption sites, but his criticism this week was not strident. (Sean Kilpatrick/Canadian Press)

​Liberals still jumped on Scheer’s other comments about dealing with drug addiction — he suggested prosecution for drug use can move people towards rehabilitation — and Conservatives responded by alleging the Liberals are somehow planning to decriminalize all narcotics.

But perhaps there is some measure of progress here anyway.

Compare Scheer in 2017 with Tony Clement’s declaration in 2008, when he was the ruling Conservative Party’s health minister, that Vancouver’s Insite was an “abomination.”

A Supreme Court ruling kept Insite operating. But when the Conservative government tabled legislation to establish new tests and requirements for establishing a similar site, the Tories sent a note to supporters entitled, “Keep heroin out of our backyards.”

“Do you want a supervised drug consumption site in your community?” wrote Jenni Byrne, the party’s campaign manager. “I don’t want one anywhere near my home.”

In the midst of the 2015 election campaign, a Conservative note warned supporters that a Liberal or NDP government would “actually expand these injection houses to neighbourhoods like yours, all across Canada.”

Back in December 2016, Scheer was warning supporters of his leadership campaign that the Liberal government “wants to impose heroin injection facilities on neighbourhoods.”

That emphasis on public consultation is still there, outright opposition may still exist in the Conservative ranks and the party might yet return to its previous tone, but Scheer’s comments this week lacked a certain stridency.

And that lack of objection may extend beyond the Conservative Party.

Opioid crisis changes context

“Whereas it took many, many years of advocacy and civil disobedience to establish a supervised injecting site in Vancouver, it’s become a lot less politicized, a lot less controversial and I think there are no really sane actors who are sitting around questioning whether there is a role for these initiatives anymore,” says Dr. Thomas Kerr, a researcher at the University of British Columbia who has studied Insite, noting that temporary facilities have been allowed to set up in Toronto and Ottawa.

The deadly opioid epidemic and the emergence of fentanyl have no doubt changed the context. At least 2,458 deaths in 2016 have been linked to opioid-related overdoses. And, unfortunately, it sometimes takes a widespread crisis to make change.

As such, it is possible a re-elected Conservative government would have also ended up expanding the number of supervised drug consumption sites. But the Liberal government, while rewriting Conservative legislation around such sites, has at least not hesitated.

The rapid increase in approvals may, in fact, result in Canada being a world leader in the use of supervised sites. According to a count from earlier this year, the Netherlands had 30 of the world’s 92 consumption sites, followed by Germany with 24.

It is tempting to wonder whether such a significant expansion of sites, which exist to save lives, reduce the spread of disease, improve public safety and encourage treatment, could invite a backlash: if improvements aren’t apparent, or surrounding neighbourhoods somehow seem to suffer.

But both Philpott and Kerr point to a different risk: that communities will think a consumption site is a solution in and of itself.

“What I might be concerned about is that I worry that people will get the message somehow that this is a panacea or a silver bullet, that it’s going to somehow magically address the really complex circumstances that we’re facing as a country in terms of the rising rates of overdose deaths,” Philpott said in an interview earlier this year. “This is one of a really broad range of tools that fall into the classic four pillar response to drug policy.”

What about decriminalization?

In terms of what else can be done, Kerr is among those who believe a different system of regulation and decriminalization is best for those dealing with addictions to drugs like heroin.

“It’s really, really hard to engage people in care when society treats them like a criminal and when they have to endure all the stigma, including in health-care settings, that arises from criminalization,” Kerr says.

The Liberal government has repeatedly ruled out decriminalization of hard drugs.

If the Canadian experience is any lesson, it might be deeply controversial and loudly opposed until, all of a sudden, it isn’t.

With the biggest drug bust in Ontario history—$250-million—the province’s cocaine supply may have just gotten more dangerous.

On August 28, Ontario Provincial Police proudly displayed a literal wall of cocaine at their headquarters. At 1,062 kilograms of pure cocaine, it was the biggest drug bust in Ontario’s history.

When massive busts such as this one occur, they’re largely perceived as a win for the police. And while it’s true that cops are just doing their jobs, what about the ripple effect for people who use drugs?

“With the amount of pure cocaine seized during Project HOPE, we’ve stopped many criminals from causing more harm to our communities while removing a quarter of a billion dollars from the criminal economy,” Ontario Provincial Police Commissioner J.V.N. Hawkes said at a press conference on Monday.

But according Nicholas Boyce, who has been working in harm reduction for over 17 years, including provincially throughout Ontario, the bust could have detrimental effects on people who use drugs.

“It’s actually going to contribute to the harm,” Boyce told VICE. “The problem is when you tackle the supply side, you’re not addressing the demand—the demand for the drugs, people who want or need them.”

Photo via Ontario Provincial Police

Boyce said that cutting off a major supply source means people may resort to finding alternatives. For example, low-level dealers may be looking for drugs similar to cocaine in order to sustain business—such as lesser-known synthetic drugs. It also could mean that with a dwindling supply, dealers will be more likely to cut their cocaine.

All of this could mean a more dangerous market for people using drugs at a time when thousands of people are already dying across the country from opioid overdoses annually.

Police nodded at the issue of cocaine being cut with other substances, saying that the Project HOPE bust prevented this from happening without acknowledging removing cocaine from the market could also lead to adulteration.

“The distribution and sales cycle would see this cocaine cut many times for street level dealers with untold, dangerous, and potentially lethal additives for higher resale value,” Hawkes said. Police claimed the street value of the over 1,000 kilos of coke they seized was $250 million.

During the press conference, Hawkes mentioned fentanyl-contaminated cocaine, referring to it as a “filler” that the product they seized would be cut with. But Boyce said that fentanyl getting into cocaine is relatively rare in Ontario—a phenomenon that is more likely accidental than intentional since cocaine is an upper and fentanyl is a downer.

Michael Parkinson of the Waterloo Region Crime Prevention Council in Ontario said that in addition to the effects people using drugs may face, a detrimental result of law enforcement crackdowns on drugs is an increase in drug-related violence.

“At the end of the day, police are required to enforce the Canadian Criminal Code, and that code is applied when upstream efforts from health, social and community sectors do not exist or have failed,” Parkinson said. “The law is an extremely expensive downstream intervention compared to potential demand-side initiatives in prevention, treatment, and harm reduction.”

Bill Bogart, author of Off the Street: Legalizing Drugs, said that the major bust will likely lead to the price of cocaine going up. It also could drive people who use cocaine to other drugs.

“Let’s step back and think about what the consequences are: It’s illusionary to think that if people can’t have access to their preferred drug, they won’t do drugs,” he said. Bogart also mentioned that if the price of cocaine rises, illegal activity to support that rise could also increase.

“People will become more desperate for cocaine because the shortage will drive up the prices, or they’ll turn to other drugs,” he said.

Bogart said that when large busts like this happen, it would make sense to put out a public health warning to people about how the drug market could become increasingly volatile, affecting supply. But in Ontario, a place where at least two people a day die from opioid overdose, this is not a system that is in place.

“There are so many missed opportunities for cross-sector collaboration on drug-related issues,” Parkinson said. A lack of resources, he said, is a major reason why these missed opportunities exist. Boyce echoed this sentiment, saying that in Ontario, there is not good sharing of information between law enforcement and health.

“The solutions are not particularly tricky, but there is simply no capacity to take in one more thing, especially since the overdose crisis has local communities running ragged and falling further behind,” Parkinson said.

Boyce stresses that with such a large bust happening, people using cocaine should take extra care to practice harm reduction measures. That means getting to know who you buy from, testing your drugs, not using alone, getting trained in using the opioid overdose antidote naloxone, and trying small amounts at a time. With the threat of fentanyl, he said, knowing if your dealer is selling other drugs, such as opioids, is critical—and ensuring that if you buy drugs, you were given the proper bag. With the popularity of party drugs, Boyce said, all venues should be keeping naloxone on-site.

“We’ve had a hundred years of drug prohibition in Canada, and drugs are still widely available and relatively cheap,” Boyce said. “This might put a small dent in things for now, but in the grand scheme of things, we’re not addressing the demand side—we’re attacking the supply.”

Ultimately, while drug use is criminalized, that demand side is unlikely to be addressed.

“The chronic concern would be the absence of non-enforcement systems to reduce the demand for substances, thus leaving enforcement and justice systems to punish the symptoms,” Parkinson said. “Those in the lurch by this bust are pretty much on their own.”

“The rising number of overdose deaths this year is horrendous and absolutely heartbreaking,” said Mayor Gregor Robertson in a press release.

“We will continue to work with the new provincial government and pour City resources into tackling this crisis. We can’t be complacent and let the number of deaths from this public health crisis be the new normal.”

First responders have handled an average of 135 overdose calls a week this year, he said.

Minister of Mental Health and Addictions Judy Darcy spent Monday checking front-line addiction services in Victoria and, in a release, said the Vancouver numbers show “there are gaps in services and there is more we need to do.”

“The feedback I am getting from people working on the front lines, people who are living with addiction and important partners like the City of Vancouver is guiding actions we are taking now and will take going forward,” she is quoted as having said.

“Mayor Robertson and I met earlier this month. The city is doing remarkable work and we are committed to working closely with them and other partners to save lives and improve access to treatment and recovery.”